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RB Y2 Renal > Acute Scrotum > Flashcards

Acute Scrotum Flashcards

1
Q

when is torsion of spermatic cord most common

A

at puberty due to enlragment of the testes

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2
Q

cause of torsion of spermatic cord

A

usually spontaneous, can occur with trauma or athletic activity

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3
Q

clinical presentation of torsion of spermatic cord

A
  • sudden onset pain and swelling, hot
  • pain in abdomen, nausea and vomiting are common
  • there sometimes may have been previous episodes of self limiting pain
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4
Q

on examination of torsion of spermatic cord

A
  • testis may lie high and transversely
  • absence of cremasteric reflex
  • hydrocele and oedema
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5
Q

cremasteric reflex

A
  • the cremaster muscle is a spiral circular muscle that surrounds the spermatic cord
  • when contracted it lifts and rotates the testes
  • touching the inner thigh triggers contraction
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6
Q

investigation of torsion of spermatic cord

A

only performed if diagnosis is equivocal - surgery must be done in under 6 hours!

  • doppler US will demonstrate lack of blood flow
  • normal blood and urine results
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7
Q

when does irreversible ischemia begin in torsion of spermatic cord

A
  • starts at 4 hours
  • surgery within 6!!
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8
Q

management of torsion of spermatic cord

A
  • 6 hours
  • obtain consent for possible orchidectomy
  • at surgery expose and untwist the testes
  • if colour looks good, fix both testes to the scrotum
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9
Q

bell clapper deformity

A
  • the tunica vaginalis joints high onto the spermatic cord
  • prone to torsion
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10
Q

torsion of appendage

A
  • this can present similarly to torsion of testis, or can be insidious
  • if seen early there may be localisd tenderness at the upper pole and a blue dot sign
  • testis should be mobile and the cremasteric reflex present
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11
Q

management of torsion of appendage

A

will resolve spontaneously without surgery

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12
Q

when does torsion of appendage usually occur

A

7-12 years

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13
Q

epididymo-orchitis

A

inflammation of the epidydmis ± testis

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14
Q

who does epididymo-orchitis tend to occur in

A
  • younger patients due to STI eg chlamydia
  • older catheterised patients
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15
Q

aetiology of epididymo-orchitis

A
  • STI eg chlamydia
  • catheter
  • spread from UTI
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16
Q

how does one distinguish epididymo-orchitis from testicuar torsion

A
  • the patients are older
  • there may be UTI symtoms
  • there is a more gradual onset of pain
  • cremasteric reflex present
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17
Q

clinical features of epididymo-orchitis

A
  • unilateral swelling and pain
  • dysuria
  • pyrexia/sweats
  • may be pyruria
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18
Q

what is common in the history of epididymo-orchitis

A
  • UTI
  • urethritis (STI) - recent unprotected sex
  • catheterization/instrumentation
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19
Q

important DD of epididymo-orchitis

A

testicular torsion – exclude urgently to prevent ischaemia of the testicle

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20
Q

important differentiating investigations/signs between torsion and epidydmo-orchitis

A
  • Elevation of testes often relieves the pain – Prehn’s sign
  • Cremasteric reflex
  • US most important differentiating
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21
Q

investigationof epididymo-orchitis

A
  • doppler will show swollen epididymis and increased blood flow
  • raised inflammatory markers
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22
Q

further investigationof epididymo-orchitis

A
  • send urine for culture
  • self taken vaso-vaginal swab for chlamydia PCR
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23
Q

management of epididymo-orchitis

A
  • analgesia and scrotal support
  • bed rest
  • drain any abscess
  • ofloxacin 400mg/day for 14 days
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24
Q

who does idiopathic scrotal oedema occur in

A

children aged 2-10 usually

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25
idiopathic scrotal oedema
* self-limiting oedema of the scrotum * these is no fever, pain or tenderness * may be itchy * not usually erythematous
26
balanitis
acute inflammation of the foreskin and glans
27
who is balanitis more common in
diabetes - may be a presenting feature of T1DM
28
genital features of T1DM
balanitis and pruritus vulvae
29
causes of balanitis
* diabetes * strep or staph * often seen in young children with tight foreskins
30
phimosis
* inability to retract the foreskin * can occlude the meastus * Predisposes to recurrent urinary tract infections and urinary tract obstruction
31
how does phimosis present in young children
* recurrent balanitis and ballooning
32
how does phimosis present in adults
painful intercourse, infection and ulceration
33
management of phimosis
* in young children the need for circumcision can be obviated by time and trials of gentle retraction * otherwise circumcision and dorsal slit
34
which pre-malignant cutaneous lesion is phimosis assoicated with
BXO - BXO can cause phimosis
35
paraphimosis
* a urological emergency where retracted foreskin cannot be put back into natural position * painful swelling of foreskin distal to a phimotic ring (which forms around the foreskin after infection, is inelastic)
36
what can paraphimosis progress to
* prevents venous return leading to oedema * then ischemia
37
management of paraphimosis
* iced glove * use granulated sugar for 1-2 hours, to draw out fluid by osmosis * multiple punctures in oedematous skin * manual compression of glans with distal traction of oedematous foreskin * dorsal slit
38
priapism
prolonged erection (\>4 hours) that is often painful and not associated with sexual arousal
39
aetiology of Priapism
* due to intra-corporeal injection for erectile dysfunction * trauma * haematologic dyscrasias eg sickle cell
40
what can be injected into the corpus cavernosum for erectile dysfunction
papaverine
41
ischaemic Priapism
* veno-occlusive or low flow * vascular stasis in the penis and decreased venous outflow is a form of compartment syndrome * the corpora cavernosa are rigid and tender and there is pain
42
non-ischaemic Priapism
* arterial/high flow * traumatic disruption of the penile vasculature results in unregulated blood entry and filling of the corpora
43
how are non/ischaemic Priapism differentiated
* low flow - dark blood, low O2 and high CO2 * high flow - normal arterial blood
44
investigation of Priapism
* colour duplex USS * low flow - minimal/absent flow in cavernosal arteries * high - flow: normal to high flow
45
management of ischaemic Priapism
* aspiration ± irrigation with saline * injection of alpha agonist (phenylephrine) * surgical shunt * if present for \>48-72 hours, it is unlikely to respond to intracaveernosal treatment * for v delayed presentation, immediate replacement may be considered
46
treatment of non-ischaemic Priapism
* observe as may resolve spontaneously * less urgent as there is no ichaemia * selective arterial embolization
47
**Fournier’s Gangrene**
* necrotizing fasciitis that occurs about the male genitalia * severe pain, fever, systeic toxicity
48
predisposing factors for **Fournier’s Gangrene**
* diabetes * trauma * periurethral extravasation * perianal infection
49
how does **Fournier’s Gangrene** start
celulitis - swollen, red and tender
50
how does **Fournier’s Gangrene** present
* marked pain, fever, systemic toxicity * swelling and crepitus (due to gas) * dark, purple areas
51
management of **Fournier’s Gangrene**
ABx and radical surgical debridement
52
mortality in **Fournier’s Gangrene**
* very high * higher in Diabetics and alcoholics
53
describe the venous drainage of the testis
* testicular veins formed from the pampniform plexus
54
investigation of testicular varicocele
* left varicocele is associated with left renal malignancy in some cases, so do an US of kidneys, ureter and bladder
55
does testicular varicocele reduce fertility?
* reduces sperm count, may be linked to subfertility
56
what movement causes a esticular varicocele to swell
standing up
57
hydrocele
* fluid in the testes, underlying teste is impalpable * common in newborns * primary idiopathic * secondary to trauma, infection and tumour
58
epidydmal cyst
* teste will be palpable
59
investigation of lumps in the testes
US
60
what are the dorsal and ventral sides of the penis
61
hypospadius
* congenital abnormality of the penis which is characterised by ventral urethral meatus, hooded prepuce and chordee (ventral curvature of the penis - downwards) * can cause urethal meatus obstruction
62
what is bladder injury often associated with
pelvic fracture
63
features of bladder injury
* suprapubic/abdominal pain and inability to void * suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminshed bowel sounds
64
imaging for bladder trauma
* CT cystography * if there is blood at external meatus or if catheter doesnt pass easily then perform retrograde urethrogram as they may well have urethral injury
65
management of bladder trauma
* large bore catheter, expect gross haematuria * ABx * repeat cystogram in 14 days
66
67
bladder rupture and exxtraperitoneal injury on imaging
flame shaped collection of contrast in pelvis
68

RB Y2 Renal (26 decks)

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